Are kegels always the answer?

Are kegels always the answer? 

Before I answer this question, I want to share a story with you.

I will never forget how excited I was to go to my six week postpartum check and get the clearance to exercise again.  Once I was cleared, I laced up my shoes to go for the run that I had been missing.  About ten minutes into my run, my shorts were as wet as a whistle.  What was this? Am I peeing my pants right now?  Everyone told me how wonderful it would be to be a mom, but NO ONE mentioned peeing my pants.

I marched back to my OB GYN to discuss this new issue.  He checked me for diastasis and pelvic floor strength and said both were good.  His answer: do kegels and when your period returns your issues will resolve.  Side note, he was a wonderful doctor but this area of women’s health is seriously lacking!!!  Anyway, I did kegel after kegel and my period returned and my issues were still there.

So to answer the question above – Yes, kegels are important, but we need to understand WHEN and HOW to do them.  For some, simply doing kegels resolves their issues and for others kegels can make symptoms worse.  Proper alignment and education on HOW to do kegels is imperative, but simply saying do more kegels is not the answer.

Why is this?

Some women have a hypotonic (underactive pelvic floor) and for those women simply doing more kegels can be very beneficial.  There pelvic floor may have “turned off” during the pushing phase and may just need some kegels to strengthen.  These women may experience leaking, hip pain, back pain, SI joint pain.

Some women have a hypertonic (overactive pelvic floor) and for these women we need to teach their pelvic floor muscles to calm down before we ask them to work.  Imagine if you were flexing your bicep and without unflexing you tried to curl 10 pounds.  That is what it’s like when you have an overactive pelvic floor, and you try to do kegels.  A good place to start for these women is meditation.  These women may experience pain with sex, trouble peeing/pooping, Tailbone pain, constipation.

For some there may be imbalances between the front vs back of the pelvic floor, or the left vs right side of the pelvic floor.  So working on connecting your pelvic floor and adjusting alignment will help.

When to kegel?

• Kegels should be done once per day where you focus on some really good contracting AND relaxing. If you have a weak pelvic floor you want to make sure you are not cheating by clenching your glutes.  If you have a tight pelvic floor you want to first work on relaxing, then contracting and finally incorporating it into your day.  You DO NOT want to hold a kegel ALL day long.
• You want to make sure you time your kegels with your breath. As you exhale, the kegel is the first muscle to respond.  Some women think they are doing a kegel when they are actually bearing down.  So timing with your breath will help with this.  In order to get a great contraction you want to make sure to fully relax on the inhale (If you struggle with PF tightness this will help and set you up for success with each rep).

What if you have been kegeling and it is not working?  The answer is NOT to do more!!

When the pelvic floor isn’t responding we need to look at what is happening with the rest of the body.  Posture and alignment of the pelvis may be impacting it.  A shallow breathing pattern may be the cause as the two systems work together to make a strong core system.  It may be that you are compensating by clenching your glutes.  Taking some time to connect and really understand where the issue lies is so important.

What to do next?

First, identify if you have a tight or weak pelvic floor.  Lying on your back you can insert you finger.  Take a nice inhale – do you feel your pelvic floor expanding like a balloon?  Now exhale and contract – do you feel the muscles tightening around your finger?  Or, do you feel pressure coming down (this is bearing down)

Second, you want to work on meditation and breathing.

Finally, you want to be able to contract and relax your pelvic floor.  Working up to 10 pelvic floor contractions holding for 10 seconds each.  As you work up to this you want to be able to time the contraction with your exhale and the relaxation with your inhale.  You need to make sure you are not bearing down and you are not clenching your glutes.  After you are strong, then you work to incorporate it into your daily activities.